Vol 4, No 1 (2018)
Review paper
Published online: 2018-03-02
Amicrobial pustulosis of the folds associated with thyroperoxidase antibodies
Forum Dermatologicum 2018;4(1):5-9.
Abstract
Amicrobial pustulosis of the folds (APF) is a rare neutrophilic dermatosis, co-existing with autoimmune disorders, especially systemic lupus erythematosus. The disease is characterized by the presence of sterile pustules localized in the skin folds, intraepidermal pustules with mainly neutrophilic infiltrate on histology, negative microbial cultures from an unopened pustule and the presence of circulating autoantibodies or autoinflammatory diseases. Due to its rare incidence, data on effective therapeutic options are limited to individual clinical cases. We present a 69-year-old man with disseminated pustular lesions in the main skin folds, focusing on the clinical, histopathological and immunological characteristics of the disease. Based on the clinical presentation and laboratory investigation, amicrobial pustulosis of the folds was diagnosed with an accompanying increased concentration of anti-thyreoperoxidase antibodies with compensated thyroid hormones. After 2 weeks of treatment with local glucocorticosteroids, skin lesions disappeared, leaving post-inflammatory discoloration. The patient remains without recurrence of any skin lesions during the five-month observation.
In conclusion, in the diagnosis of this rare disease, the clinicopathological correlation plays a crucial role as well as the investigation for co-existing autoimmune disorders.
Keywords: amicrobial pustulosis of the foldsaseptic pustulosisneutrophilic dermatosispustular dermatosis
References
- Marzano AV, Ramoni S, Caputo R. Amicrobial pustulosis of the folds. Report of 6 cases and a literature review. Dermatology. 2008; 216(4): 305–311.
- Schissler C, Velter C, Lipsker D. Amicrobial pustulosis of the folds: Where have we gone 25years after its original description? Ann Dermatol Venereol. 2017; 144(3): 169–175.
- Marzano AV, Borghi A, Wallach D, et al. A comprehensive review of neutrophilic diseses. Clinic Rev Allerg Immunol. 2017 Jul 7.
- Crickx B, Diego ML, Guillevin L, et al. Pustulose amicrobienne et lupus érythémateux systémique. Journées Dermatologiques de Paris 1991; Mar: Communication n. : 11.
- Wang MZ, Camilleri MJ, Guo R, et al. Amicrobial pustulosis of the folds: Report of 4 cases. J Cutan Pathol. 2017; 44(4): 367–372.
- Claeys A, Bessis D, Cheikhrouhou H, et al. Amicrobial pustulosis of the folds revealing asymptomatic autoimmune thyroiditis. Eur J Dermatol. 2011; 21(4): 641–642.
- López-Navarro N, Alcaide A, Gallego E, et al. Amicrobial pustulosis of the folds associated with Hashimoto's thyroiditis. Clin Exp Dermatol. 2009; 34(8): e561–e563.
- Lagrange S, Chosidow O, Piette JC, et al. A peculiar form of amicrobial pustulosis of the folds associated with systemic lupus erythematosus and other auto-immune diseases. Lupus. 1997; 6(6): 514–520.
- Inui S, Azukizawa H, Asada H, et al. Amicrobial pustulosis with antinuclear antibodies and rheumatoid factor. Br J Dermatol. 2006; 154(3): 568–569.
- Marzano AV, Tavecchio S, Berti E, et al. Cytokine and chemokine profile in amicrobial pustulosis of the folds: evidence for Autoinflammation. Medicine (Baltimore). 2015; 94: e2301.
- Kerl K, Masouyé I, Lesavre P, et al. A case of amicrobial pustulosis of the folds associated with neutrophilic gastrointestinal involvement in systemic lupus erythematosus. Dermatology. 2005; 211(4): 356–359.
- Amazan E, Ezzedine K, Mossalayi MD, et al. Expression of interleukin-1 alpha in amicrobial pustulosis of the skin folds with complete response to anakinra. J Am Acad Dermatol. 2014; 71(2): e53–e56.
